Overmedicated and Unsupervised: The Overmedication of Children in Foster Care

Imagine walking into a doctor’s office and being prescribed one, maybe even more than one, medication for a mental illness you do not believe you have and having no choice on whether or not you will take this drug. The drug has significant negative side effects and the long-term effects of it have not been documented. No questions are asked, and the prescription is filled. To many of us, this situation seems unfathomable and unrealistic. For foster children, however, this is often the case.

At the end of the 2012 fiscal year, more than 400,000 children were living in foster care. Children in foster, by definition, are eligible for Medicaid coverage. These children, however, are prescribed psychotropic medications at far higher rates than other children who are covered by Medicaid. The doses that they are prescribed often exceed the Food and Drug Administration guidelines and many of the medications are not even approved for children.

Data from the Department of Health and Human Services (HHS) shows that 18 percent of children in foster care are taking at least one psychotropic medication. The Government Accountability Office (GAO) estimated this number to be even higher at 21 to 39 percent of foster children. Some of these children are taking medication from five different classes of drugs, ranging from antidepressants to stimulants, antipsychotics, mood stabilizers, anxiolytics and hypnotics. In the foster care population, 80 percent of children are diagnosed with a mental disorder, compared to just 20 percent in the general population.

Unlike children diagnosed and treated for mental illness who are a part of an intact family, children in foster care do not have a consistent individual monitoring their treatment and improvement. Children in foster care have usually suffered multiple traumas, whether that be abuse, neglect or the constant pattern of uprooting and moving from one foster home to another. Cognitive, physical, emotional and behavioral development and functioning can all be negatively affected as a result of these distressing experiences.

The Center for Health Care Strategies concludes that foster care children are a high-cost Medicaid population. Though they only represent 3.2 percent of children covered by Medicaid, foster care children have the highest rate for use of behavioral health services, 32 percent of them use these services compared to 26 percent of children on Supplemental Security Income (SSI) and 4.6 percent of Temporary Assistance for Needy Families (TANF). Children in foster care also have the highest mean behavioral health expenditure, $8,094 per child, almost $1,000 more than aid provided to children in other categories. On average, children in foster care who use behavioral health services have health care expenditures that are seven timeshigher than that of children covered by Medicaid in general.

A few weeks ago, the House Committee on Ways and Means, Subcommittee on Human Resources held a hearing entitled, “Hearing on Caring for Our Kids: Are We Overmedicating Children in Foster Care?” In recent years, Congress has passed legislation to improve and provide regulation for the access to health and mental services, assessment and consultation with a doctor and prescription of psychotropic medications for children in foster care. These bills, now public laws, include the Child and Family Improvement Act of 2006 (Public Law 109-288), The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Public Law 110-351), and the Child Family Services Improvement Innovation Act of 2011 (Public Law 112-34). Additionally, states such as Connecticut, Illinois and Texas have taken strides to improve the process of approving new prescriptions and monitoring the dispersion of existing prescriptions (Ways and Means).

Solutions for this pressing issue include access and funding for evidence-based treatments and improved oversight of psychotropic drug prescriptions. The Administration for Children and Families requested $250 million over five years to fund this infrastructure for the training in addition to the Center for Medicare and Medicaid Services investment of $500 million over five years, which would provide incentive payments to the states to implement programs that would measure state-wide improvement. Hopefully, these requests will be granted and children in foster care will be able to receive the best and most effective treatments our health care system has to offer.